OFSPINALCORD090312脊髓疾病課件

liang1931@126.comliang1931@126.com1ChristorphReeve,knownasthestaractorof“Superman”（超人）,fellfromhorsewhenridingandbecametetraplegia（四肢癱）

in1995，anddiedin2007ChristorphReeve,knownasth2SimilaraccidenttookplacewhenChinesegymnasticsathlete,Sanlan（桑蘭）,wasexercisinginthe4thGoodwillGamesinNewYorkon21stJuly,1998.Thecervicalspineinjuryledtotetraplegia.Similaraccidenttookplacewh3Zhanghaidi（張海迪）,shehadhemangioma(血管瘤）inT2,brokeupinherfiveyears,thebleedingcompressedthespinalcordcausedparalysis(截癱)Zhanghaidi（張海迪）,shehadheman4Lou

Gehrig(1903~1941),oneofthebestbaseballplayerintheworld,wassuchaALS（肌萎縮側(cè)索硬化）patient.（LouGehrigdisease)LouGehrig(1903~1941),oneof5StephenHawking,ageniusphysicist,isanothercaseofALS.StephenHawking,ageniusphy6Chapter4

SpinalCord

Diseases

(脊髓疾病)

Purpose：1)

Comprehend:Thegeneralpictureofspinalcorddiseases;

2)Acquaint:

Clinicalmanifestation,diagnosisanddifferentialdiagnosis,treatmentprincipleofacutemyelitis

（急性脊髓炎）&spinalcordcompression

（脊髓壓迫癥）3)Grasp:threemainsymptoms&localization(定位)ofSpinalCordDiseasesTeachinghour：2lecturinghoursChapter4SpinalCord

Disea7CONTENTS

Part1AnatomyPart2ManifestationsPart3LesionLocalizationPart4AcutemyelitisPart5Compressivemyelopathy

Part6

VascularMyelopathiesPart7Syringomyelia&

CONTENTS

Part8PARTONEANATOMYPARTONEANATOMY9

SpinalCordAnatomyRelevanttoClinicalSignsLieswithinthevertebralcanalMedullaoblongata→foramenmagnum→levelofthefirstlumbarvertebraLowerend—conusmedullaris（圓錐）→filumterminale（終絲）→coccyxSpinalCordAnatomyRelevant10Allthespinalnervesbelowthefisrtlumbarformingthecaudaequina(馬尾）twoenlargements:

Cervical(C5-T2)

Lumbar(L1-S2)31pairsofspinalnerves(dorsalrootandventralroot)Allthespinalnervesbelowth11Spinalsegmentsdonotcorrespondnumericallywithenclosedvertebra.31segmentsofspinalcord:eightcervical,

twelvedorsalorthoracic,fivelumbar,

fivesacral,

onecoccygeal.Thelengthofspinalcord:about2/3ofthevertebras.Spinalsegmentsdonotcorresp12SpinalCordLevelsRelativetotheVertebralBodySpinalcordlevelCorrespondingVertebralBodyCervical(Forex:C6)C6-1=C5Upperthoracic(T1~6)(Forex:T5)T5-2=T3Lowerthoracic(T7~12)(Forex:T9)T9-3=T6LumbarT10~12SacralT12~L1CoccygealL1SpinalCordLevelsRelativeto13

ThreeMeningiesPiamater（軟腦膜）:formstheimmediatecoveringofthecordArachnoid（珠網(wǎng)膜）:liessuperficallytothepiamaterDuramater（硬腦膜）:outsidethearachnoidThreeMeningiesPiamater（軟14Arachnoidspace:containscerebrospinalfluid(CSF)（腦脊液）Epiduralspace:containsfattytissue,venousplexusTwospacesArachnoidspace:containscere15Twoanteriorhorns----motorcellsTwoposteriorhorns-----sensorycellsLateralhorns-----autonomiccellsTheStructureInsidetheSpinalCordTwoanteriorhorns----motorce16TwoanteriorcolumnTwoposteriorcolumnTwolateralcolumn

AllfibersPeripheralwhitematter:TwoanteriorcolumnPeripheral17AscendingPathways

Lateralspinothalamictract（脊髓丘腦側(cè)束）:conductsuperficialsensationVentralspinothalamictract（脊髓丘腦前束）TractsofGracilisandCuneatus（薄束和楔束）:conductdeepsensationAscendingPathwaysLateralspin18OFSPINALCORD090312脊髓疾病課件19OFSPINALCORD090312脊髓疾病課件20DescendingPathwaystheimportantoneis:Corticospinaltract

(皮質(zhì)脊髓束）orpyramidaltract（錐體束）,conveymotorimpulsesfromcerebralcortextospinalcordDescendingtheimportantoneis21BloodSupplyTwoposteriorspinalarteriessupplythebloodtoposteriorcolumnandposteriorhorn(1/3)BloodSupplyTwoposteriorspin22

Supplythebloodtocentralgreymatter,anteriorcolumns,pyramidaltract(2/3)SingleanteriorspinalarterySupplythebloodtocentra23Unitesthespinalarteriestosupplythewhitematterandmostpartoftheposteriorhorn.ArterialcoronaUnitesthespinalarteriesto24PARTTWOMANIFESTATIONS（臨床表現(xiàn)）

PARTTWOMANIFESTATIONS25ThreeMainSymptomsofspinalcorddiseases1.Motordisturbance

UpperMotorNeuronParalysis(Spasticparalysis)（痙攣性癱）causedby:PyramidaltractlesionLowerMotorNeuronParalysis(Flaccidparalysis（弛緩性癱）causedby:

anteriorhorn/ventralrootlesionSensationdisturbance,causedby:spinothalamic,gracilisandcuneatustractslesion;

posteriorhorn/posteriorrootlesionAutonomicfunctiondisturbance:sphincterdysfunction，lackofsweating,skinulcerThreeMainSymptomsofspinal26Threetypesoflesion

ofspinalcordSelectivelesion(Locallesion)

（局灶性損害）2.Semitransverselesion（半橫貫性損害）(Brown-Sequardsyndrome)3.Completetransverselesion

（完全性橫貫性損害）Threetypesoflesion

ofspi271.SelectiveLesion(LocalLesion)(includingsixgroups)1.SelectiveLesion28

（1）AnteriorHornLesionSymptom:

flaccidparalysis(弛緩性麻痹）(lowermotorneuronlesion)Diseases:Acutepoliomyelitis（急性脊髓灰質(zhì)炎，也稱小兒麻痹癥）Progressivespinalmuscularatrophy（進(jìn)行性脊肌萎縮癥）（1）AnteriorHornLesionSympto29（2）PyramidalTractlesionSymptom:

Spasticparalysis(Uppermotorneuronlesion)Disease:

Primarylateralsclerosis(原發(fā)性側(cè)索硬化）（2）PyramidalTractlesionSympt30（3）Anteriorhorn+PyramidaltractSymptom:(cervicalenlargementlesion)Flaccidparalysis+spasticparalysisonthehands；spasticparalysisonthelegsDisease:

Amyotrophiclateralsclerosis(ALS)（肌萎縮性側(cè)索硬化）（3）Anteriorhorn+Pyramidaltra31（4）PosteriorColumnLesionSymptom:DeepsensationdisturbanceDisease:

Tabesdorsalis（脊髓癆）（4）PosteriorColumnLesionSymp32(5)PosteriorColumn+PyramidalTractSymptom:deepsensationdisturbance+spasticparalysisDisease:

Subacutecombineddegenerationofthespinalcord（脊髓亞急性聯(lián)合變性）(5)PosteriorColumn+Pyramidal33（6）LesionInTheGrayMatterSymptom:

dissociated（分離性）sensorydisturbance，segmentalsensoryloss，muscleswastinginthehandsNutritiondisturbance

Disease:

Syringomyelia（脊髓空洞癥）Spinalhemorrhage（脊髓出血）（6）LesionInTheGrayMatterSy342.Semitransverselesion（半橫貫損害）(Brown-Sequardsyndrome)

Onthesideofthelesion:limb(s)spasticparalysis,deepsansationlostOntheoppositesideofthelesion:superficialsansationlost

2.Semitransverselesion（半橫貫損害353.Completetransverselesion（完全性橫貫性損害）Acutemyelitis,traumaBelowthelevelofthelesion：Spasticparalysis(痙攣性截癱)CompletelossofallmodalitiessensationSphincterdisturbances3.Completetransverselesio36PARTTHREELesionlocalization(病灶定位）PARTTHREELesionlocaliz37Theuppercervicalregion(C1-4)Pyramidaltractsigns(錐體束征)infourlimb-----slightdamageTetraplegia(quadriplegia)(四肢癱)-------severedamage

PainintheneckandocciputTheuppercervicalregion(C1-382.Thecervicalenlargement(C5-T2)Flaccid&spasticparalysis+segmentalsensorydisturbanceintheupperlimbsSpasticparalysisinthelowerlimbs2.Thecervicalenlargement(C5393.

ThethoracicregionSpasticparalysisinthelowerlimbsSensationlostbelowthelevelofthelesion3.ThethoracicregionSpastic404.Thelumbarenlargement(L1-S2)inthelowerlimbs:Flaccidparalysis

Segmentalsensorydisturbance4.Thelumbarenlargement(L1-S415.Theconusmedullaris(L3-5)andcoccyx:Sensationlossintheperineum（會(huì)陰）andbuttocks（臀部）in“saddleshaped”（馬鞍型）distribution,sphincterdisturbance5.Theconusmedullaris(L3-5)426.ThecaudaequinaAtrophicparalysisbelowtheknee,

saddle-shapedsensationdisturbance,paininthelowerlimbs,

disturbanceofthebladderandbowel6.ThecaudaequinaAtrophic43PARTFOURACUTEMYELITIS（急性脊髓炎）PARTFOURACUTEMYELITIS44DEFINITIONAnonspecificInflammationofthespinalcord,including:

transverse(橫貫性)myelitis

ascending(上升性)myelitisdisseminate(播散性)myelitisDEFINITIONAnonspecificInflam45ETIOLOGYStillunknown,maybe:

anindirectautoimmuneattacktriggeredbyinfectionorrecentvaccination,causestheinflammationofthespinalcord.ETIOLOGYStillunknown,maybe:46PATHOLOGYThesiteofInflammation:edemaandhyperemia.Theleptomeninges:congestedandinfiltratedwithinflammatorycells.Thesubstanceofthecord:congestion,perivascularinflammatoryInfiltration.PATHOLOGYThesiteofInflammat47Thecellsofthegreymatter:DegenerationThewhitematter:

Demyelinatedofthemyelinsheaths(髓鞘)

Degenerationoftheaxiscylinders(軸索)Thecellsofthegreymatter:48Acutemyelitis

急性脊髓炎MRIT1T2Acutemyelitis急性脊髓炎MRIT1T49MANIFESTATIONAgeofonset:most20~40yearsold.BothsexesoccurOnsetisacute,anupperrespirationinfection(URI)2~3daysbefore,apainatthebackcorrespondingtothelesion(T3-5)Initialsymptom:weaknessandnumbnessinlowerlimbsMANIFESTATIONAgeofonset:mos50Symptomsandsignsofatransverselesionofspinalcordoccurrapidly①M(fèi)otorsymtoms:paraplegia

Earlystage:spinalshock(脊髓休克）similartothatofflaccidparalysis.Afterafewdaysormore,graduallychangetospasticparalysis.Symptomsandsignsofatransv51②sensoryloss:belowthelesion,allmodalitiessensation

completeorincompleteloss,exhibitinganupperlevelcorrespondingtotheaffectedsegmentsite.②sensoryloss:belowthelesi52③impairmentofsphinctercontrol:retentionintheurineandfeces,laterchangingtoautomaticempty（自動(dòng)膀胱）.④

automatic

symptoms:overthepartsofparalysis,lackofsweating,edema,etc.③impairmentofsphinctercon53

After3～4weeksormore,recovergradually.Threecomplicationsshouldbestressed:

urinarytractinfection,bedsore（褥瘡）,pneumonia,

preventionisveryimportant.After3～4weeksormore,reco54AuxiliaryExaminationPeripheralbloodWBCcountelevatesslightlyinacutestage.CSF:Bothprotein(0.5-1.2g/L)andwhitecells(20-200)×106/Lincreaseslightlysometimesmoderately.Noobstructionfoundinthevertebralcanal.CTorMRIrevealsthelesion.AuxiliaryExaminationPeriphera55DIAGNOSISRapidonsetofthesymptomsandsignsofatransverselesionofthespinalcord.ChangesofCSF.MRIabnormalsignal.DIAGNOSISRapidonsetofthesy56DifferentialdiagnosisAcuteepiduralabscess(急性硬膜外膿腫):Severepain,highfever,highWBC,primaryinfectiouslesionfoundelsewhere.DifferentialdiagnosisAcuteep57

Somefever,fatigue,tendernessanddeformityofthediseasedvertebra.ThisdiseaseconfirmedbytheX-raycheck,CTorMRITuberculousspinalosteitis(結(jié)核性脊椎炎)Somefever,fatigue,tender58

Metastasesofthespine：Severerootpainappearsearly,primarylesionfoundinotherpartofthebody.Agedpersonisfavorabletohavethisdisorder,distinguishingbytheX-ray、CTorMRI.胸椎轉(zhuǎn)移瘤（肝臟轉(zhuǎn)移）胸椎轉(zhuǎn)移瘤Metastasesofthespine：胸椎轉(zhuǎn)移59.Neuromyelitisoptica(Devicdisease)(視神經(jīng)脊髓炎):prominantsymptomofopticneuritisoccurringbeforeorafterthemyelitis,occasionalsimultaneously..Neuromyelitisoptica(Devic60Hematomyelia(脊髓出血):

Anacutepainfultransversemyelopathy,thecentralgreymatterismuchdamagedthanthewhitematter.DiagnosisisbestmadebyCTorMRI.Hematomyelia(脊髓出血):61血管畸形并出血血管畸形并出血62TreatmentAdrenalGlucocorticoidSteroid(腎上腺糖皮質(zhì)激素)(AGCS)pulsetherapy(沖擊療法):Initial:methyprednisolone(甲強(qiáng)龍)500-1000mg,i.v.dripin3-5days,followingbymedrol(美卓樂)orprednisone(潑尼松)oralforseveralweeksormonths.Antibiotics3.Vitamins(B1,B6,B12)4.Intravenousimmunoglobulin(IVIg)TreatmentAdrenalGlucocorticoi63Generalmeasuresincludingcareoftheskinandurinarytractparticularly.Earlyinstitutionofphysicaltherapy,

suchasmassage,acupuncture,andothermeasures-rehabilitation.Generalmeasuresincludingcar64Antibiotics(抗生素）Steriod(激素）Vitamin(維生素）Diaper(尿布）

+Antibiotics(抗生素）Steriod(激素）Vi65PARTFIVECompressivemyelopathy(spinalcordcompression)（壓迫性脊髓病）PARTFIVECompressivemyelopath66DefinitionAgroupofdiseasescausedbytheoccupied(占位性)lesionswithinthevertebralcanal,leadstocompressthespinalcord,occurringrelevantsymptomsandsigns.DefinitionAgroupofdiseases67OFSPINALCORD090312脊髓疾病課件68EtiologyDiseaseofthevertebralcolumn：(1)Trauma

vertebrafracturewithspinalcordcutoffEtiologyDiseaseofthevertebr69(2)Tuberculousosteitis(3)Tumorofthevertebra(2)Tuberculousosteitis(3)70Diseaseofthemeninges：Arachnoiditis（蛛網(wǎng)膜炎）,leukemiainfiltrated（白血病浸潤(rùn)）EpiduraabscessEpiduraabscess(硬膜外膿腫)Diseaseofthemeninges：Arach71Astrocytomaofthespinalcord(脊髓星形細(xì)胞瘤)Diseaseofextramedullay(脊髓外）orintramedullay（脊髓內(nèi))

Astrocytomaofthespinalcord72Schwannoma

(神經(jīng)鞘瘤)Lipoma(脂眆瘤)SchwannomaLipoma(脂眆瘤)73Gd-DTPAT1WIT1WIMeningioma(脊膜瘤)Gd-DTPAT1WIT1WIMeningioma74EffectsofcompressionuponthecordDirectpressureinterfereswithconductioninthespinalrootsandinthecord.Compressionofthearteriesleadstoischemiaofthesegmentsofthecord.Effectsofcompressionuponth75Pressureuponthespinalveinsleadstoedemaofthecordbelowthesiteofcompression.ObstructionofthesubarachnoidspaceleadstochangesofCSF．Pressureuponthespinalveins76MANIFESTATIONModeofonset:Acute:injury

subacute:arachnoiditischronic:extramedullarytumorMANIFESTATIONModeofonset:77OFSPINALCORD090312脊髓疾病課件782.Sensorysymptoms

Painsradiatinginthedistributionofoneormorespinalroots,unilateralorbilateral.Paresthesiainthelimbs.

2.Sensorysymptoms79Compressionofspinothalamictractlocatedintheaffectedside→impairmentofappreciationofpain,heatandcoldontheoppositesideofthebody.(Brown-SequardSyndrome)Compressionofspinothalamict80Compressionofcorticospinaltract→spasticparesisofthelimb/limbsbelowthelevelofthelesion.Compressionoftheventralroots/anteriorhorn→aprogressivelowermotorneuronlesion.3.MotorsymptomsCompressionofcorticospinalt814.Thereflexes:Compressionofthespinalcordatagivensegmentallevel→diminutionorlossofreflexes.4.Thereflexes:Compressionof82thetendonreflexesbelowthelevelofthelesionarehyperactive;

pathologicalreflexespositive;cremasteric(提睪)&abdominalreflexescannotbeelicited.Compressionofthecorticospinaltractthetendonreflexesbelowthe835.

Autonomicsymptoms:

Thesphinctersdisturbancelateroccur

6.Thespine:deformity,tenderness5.Autonomicsymptoms:Thesph84AuxiliaryExamination①Radiography②Myelography(脊髓造影）③CTscan,MRI④CSFAuxiliaryExamination①Radiogr85DiagnosisandDifferentialDiagnosis

1.Differentiatefromthenon-compressivediseases:Acuteonset:occurringcompleteorincompletetransverselesions

Chroniconset:occurringrootpain,Brown-SequardsyndromeDiagnosisandDifferentialDia86Differentialdiagnosis:Rootpain:Pleurisy,(胸膜炎）,anginapectoris（心絞痛）,cholecystitis（膽囊炎）,etc.Cordtransverselesion:multiplesclerosis,syringmyelia,motorneurondisease,etc.Differentialdiagnosis:Rootpa87Localizationoftheaffectedsegmentallevel:

rootpain,Segmentalatrophicmuscles,

changeofreflexes,theupperlimitofsensoryloss.Localizationoftheaffected88ManifestionExtradural（硬膜外）Extramedullary(脊髓外)Intramedullary（髓內(nèi)）RootpainsocccurearlyearlylessfrequentSymptomsdevelopbilaterall,symmetricalUnilateraltobilateralbilareral,

symmetricalMotorsymptomsappearfirstearlierearlierSensory

changeslateearlyearlySphincterdisturbanceslaterlaterearlyProteincontent

ofCSFslightincreasedhighlowerTodeterminethelocationofthelesionManifestionExtraduralExtramedu894.DiagnosisofthecausesofcompressionAccordingto:

modeofonset,symptomsandsignsofthecord,ChangeofCSF,symptomsdevelop,X-ray,CT,MRI.

4.Diagnosisofthecausesof90TreatmentTheappropriatetreatmentofthesource.Forexample:Tuberculousspinalosteitis(antituberculoustherapy+appropriateoperation),extraduralabscess(earlyoperation+adequateantibioticstherapy),spinaltumor(operation).2.RehabilitationTreatmentTheappropriatetreat91PartFiveVascularMyelopathies脊髓血管病PartFiveVascularMyelopathies92Typesofvascularmyelopathies1.

InfarctionoftheSpinalCord

2.Hematomyelia(脊髓出血)3.Arteriovenousmalformation(AVM)

（動(dòng)靜脈畸形）Typesofvascularmyelopathies93Zhanghaidi,shehadhemangioma(血管瘤)inT2,brokeupinherfiveyears,thebleedingcompressedthespinalcordcausedparalysis.Zhanghaidi,shehadhemangioma94Hematomyelia(脊髓出血):

Anacutepainfultransversemyelopathy,thecentralgreymatterismuchdamagedthanthewhitematter.Diagnosis:bestmadebyCTorMRI.

Treatment:conservativetherapyoroperationHematomyelia(脊髓出血):95血管畸形并出血血管畸形并出血96PARTSIXSYRINGOMYELIA（脊髓空洞癥）PARTSIXSYRINGOMYELIA（脊髓空洞癥）97SyringomyeliaSyringomyelia98Definition

Acavityexpansionofthespinalcordproducesaprogressivemyelopathy.Ifthecavityextendstothemedullaroblongata-------syringobulbia(延髓空洞癥)Definition

Acavityexpansion99Etiology

Developmentaldisordersoftheposteriorfossa(后顱窩）andforaminamagnum（枕骨大孔）CongenitalmalformationofthecentralcanalofthespinalcordObstructionoftheforaminamagnum.EtiologyDevelopmentaldisorde100PathologyCavityfillswithliquorsimilartoCSF.Cavityexpansionfirstaffectstheposteriorhorn→anteriorhorn→lateralhorn→desendingandascendingpathways.PathologyCavityfillswithliq101ManifestationsDiseaseoccursin20～30yearsold,developinginsidiously.

ManifestationsDiseaseoccurs1022.Classicalsymptoms

Dissociated（分離性）sensorydisturbance(painandtemperaturesensationslost,deepandtouchsensationpreserved,ifthelesion:symmatrical:theditributionlikeacape(背心)

asymmetrical:likehalfofacape.2.Classicalsymptoms103HyporeflexesMuscleswastinginthehandsNutritiondisturbance:

skinulcers,sweatingabnomalCharcot’sjoints(enlargement,deformitywithoutpain)

Classicalsyndromes(continued)HyporeflexesClassicalsyndrom104

Auxiliaryexamination①DMCT（延遲性CT造影）②MRIAuxiliaryexamination①DMCT105DiagnosisandDifferential

diagnosis①Intramedullarytumor②Amyotrophic

lateral

sclerosis(ALS)（肌萎縮側(cè)索硬化）③Leprosy(麻風(fēng))DiagnosisandDifferential

di106TreatmentThedrugsforthisdiseasearelimitedLargecavity——operationTreatmentThedrugsforthisdi107THANKYOUTHANKYOU108liang1931@126.comliang1931@126.com109ChristorphReeve,knownasthestaractorof“Superman”（超人）,fellfromhorsewhenridingandbecametetraplegia（四肢癱）

in1995，anddiedin2007ChristorphReeve,knownasth110SimilaraccidenttookplacewhenChinesegymnasticsathlete,Sanlan（桑蘭）,wasexercisinginthe4thGoodwillGamesinNewYorkon21stJuly,1998.Thecervicalspineinjuryledtotetraplegia.Similaraccidenttookplacewh111Zhanghaidi（張海迪）,shehadhemangioma(血管瘤）inT2,brokeupinherfiveyears,thebleedingcompressedthespinalcordcausedparalysis(截癱)Zhanghaidi（張海迪）,shehadheman112Lou

Gehrig(1903~1941),oneofthebestbaseballplayerintheworld,wassuchaALS（肌萎縮側(cè)索硬化）patient.（LouGehrigdisease)LouGehrig(1903~1941),oneof113StephenHawking,ageniusphysicist,isanothercaseofALS.StephenHawking,ageniusphy114Chapter4

SpinalCord

Diseases

(脊髓疾病)

Purpose：1)

Comprehend:Thegeneralpictureofspinalcorddiseases;

2)Acquaint:

Clinicalmanifestation,diagnosisanddifferentialdiagnosis,treatmentprincipleofacutemyelitis

（急性脊髓炎）&spinalcordcompression

（脊髓壓迫癥）3)Grasp:threemainsymptoms&localization(定位)ofSpinalCordDiseasesTeachinghour：2lecturinghoursChapter4SpinalCord

Disea115CONTENTS

Part1AnatomyPart2ManifestationsPart3LesionLocalizationPart4AcutemyelitisPart5Compressivemyelopathy

Part6

VascularMyelopathiesPart7Syringomyelia&

CONTENTS

Part116PARTONEANATOMYPARTONEANATOMY117

SpinalCordAnatomyRelevanttoClinicalSignsLieswithinthevertebralcanalMedullaoblongata→foramenmagnum→levelofthefirstlumbarvertebraLowerend—conusmedullaris（圓錐）→filumterminale（終絲）→coccyxSpinalCordAnatomyRelevant118Allthespinalnervesbelowthefisrtlumbarformingthecaudaequina(馬尾）twoenlargements:

Cervical(C5-T2)

Lumbar(L1-S2)31pairsofspinalnerves(dorsalrootandventralroot)Allthespinalnervesbelowth119Spinalsegmentsdonotcorrespondnumericallywithenclosedvertebra.31segmentsofspinalcord:eightcervical,

twelvedorsalorthoracic,fivelumbar,

fivesacral,

onecoccygeal.Thelengthofspinalcord:about2/3ofthevertebras.Spinalsegmentsdonotcorresp120SpinalCordLevelsRelativetotheVertebralBodySpinalcordlevelCorrespondingVertebralBodyCervical(Forex:C6)C6-1=C5Upperthoracic(T1~6)(Forex:T5)T5-2=T3Lowerthoracic(T7~12)(Forex:T9)T9-3=T6LumbarT10~12SacralT12~L1CoccygealL1SpinalCordLevelsRelativeto121

ThreeMeningiesPiamater（軟腦膜）:formstheimmediatecoveringofthecordArachnoid（珠網(wǎng)膜）:liessuperficallytothepiamaterDuramater（硬腦膜）:outsidethearachnoidThreeMeningiesPiamater（軟122Arachnoidspace:containscerebrospinalfluid(CSF)（腦脊液）Epiduralspace:containsfattytissue,venousplexusTwospacesArachnoidspace:containscere123Twoanteriorhorns----motorcellsTwoposteriorhorns-----sensorycellsLateralhorns-----autonomiccellsTheStructureInsidetheSpinalCordTwoanteriorhorns----motorce124TwoanteriorcolumnTwoposteriorcolumnTwolateralcolumn

AllfibersPeripheralwhitematter:TwoanteriorcolumnPeripheral125AscendingPathways

Lateralspinothalamictract（脊髓丘腦側(cè)束）:conductsuperficialsensationVentralspinothalamictract（脊髓丘腦前束）TractsofGracilisandCuneatus（薄束和楔束）:conductdeepsensationAscendingPathwaysLateralspin126OFSPINALCORD090312脊髓疾病課件127OFSPINALCORD090312脊髓疾病課件128DescendingPathwaystheimportantoneis:Corticospinaltract

(皮質(zhì)脊髓束）orpyramidaltract（錐體束）,conveymotorimpulsesfromcerebralcortextospinalcordDescendingtheimportantoneis129BloodSupplyTwoposteriorspinalarteriessupplythebloodtoposteriorcolumnandposteriorhorn(1/3)BloodSupplyTwoposteriorspin130

Supplythebloodtocentralgreymatter,anteriorcolumns,pyramidaltract(2/3)SingleanteriorspinalarterySupplythebloodtocentra131Unitesthespinalarteriestosupplythewhitematterandmostpartoftheposteriorhorn.ArterialcoronaUnitesthespinalarteriesto132PARTTWOMANIFESTATIONS（臨床表現(xiàn)）

PARTTWOMANIFESTATIONS133ThreeMainSymptomsofspinalcorddiseases1.Motordisturbance

UpperMotorNeuronParalysis(Spasticparalysis)（痙攣性癱）causedby:PyramidaltractlesionLowerMotorNeuronParalysis(Flaccidparalysis（弛緩性癱）causedby:

anteriorhorn/ventralrootlesionSensationdisturbance,causedby:spinothalamic,gracilisandcuneatustractslesion;

posteriorhorn/posteriorrootlesionAutonomicfunctiondisturbance:sphincterdysfunction，lackofsweating,skinulcerThreeMainSymptomsofspinal134Threetypesoflesion

ofspinalcordSelectivelesion(Locallesion)

（局灶性損害）2.Semitransverselesion（半橫貫性損害）(Brown-Sequardsyndrome)3.Completetransverselesion

（完全性橫貫性損害）Threetypesoflesion

ofspi1351.SelectiveLesion(LocalLesion)(includingsixgroups)1.SelectiveLesion136

（1）AnteriorHornLesionSymptom:

flaccidparalysis(弛緩性麻痹）(lowermotorneuronlesion)Diseases:Acutepoliomyelitis（急性脊髓灰質(zhì)炎，也稱小兒麻痹癥）Progressivespinalmuscularatrophy（進(jìn)行性脊肌萎縮癥）（1）AnteriorHornLesionSympto137（2）PyramidalTractlesionSymptom:

Spasticparalysis(Uppermotorneuronlesion)Disease:

Primarylateralsclerosis(原發(fā)性側(cè)索硬化）（2）PyramidalTractlesionSympt138（3）Anteriorhorn+PyramidaltractSymptom:(cervicalenlargementlesion)Flaccidparalysis+spasticparalysisonthehands；spasticparalysisonthelegsDisease:

Amyotrophiclateralsclerosis(ALS)（肌萎縮性側(cè)索硬化）（3）Anteriorhorn+Pyramidaltra139（4）PosteriorColumnLesionSymptom:DeepsensationdisturbanceDisease:

Tabesdorsalis（脊髓癆）（4）PosteriorColumnLesionSymp140(5)PosteriorColumn+PyramidalTractSymptom:deepsensationdisturbance+spasticparalysisDisease:

Subacutecombineddegenerationofthespinalcord（脊髓亞急性聯(lián)合變性）(5)PosteriorColumn+Pyramidal141（6）LesionInTheGrayMatterSymptom:

dissociated（分離性）sensorydisturbance，segmentalsensoryloss，muscleswastinginthehandsNutritiondisturbance

Disease:

Syringomyelia（脊髓空洞癥）Spinalhemorrhage（脊髓出血）（6）LesionInTheGrayMatterSy1422.Semitransverselesion（半橫貫損害）(Brown-Sequardsyndrome)

Onthesideofthelesion:limb(s)spasticparalysis,deepsansationlostOntheoppositesideofthelesion:superficialsansationlost

2.Semitransverselesion（半橫貫損害1433.Completetransverselesion（完全性橫貫性損害）Acutemyelitis,traumaBelowthelevelofthelesion：Spasticparalysis(痙攣性截癱)CompletelossofallmodalitiessensationSphincterdisturbances3.Completetransverselesio144PARTTHREELesionlocalization(病灶定位）PARTTHREELesionlocaliz145Theuppercervicalregion(C1-4)Pyramidaltractsigns(錐體束征)infourlimb-----slightdamageTetraplegia(quadriplegia)(四肢癱)-------severedamage

PainintheneckandocciputTheuppercervicalregion(C1-1462.Thecervicalenlargement(C5-T2)Flacc